Health Care Professional Information

Brand Name

Juice Plus+®

Clinical Summary

Juice Plus (JP) is a formulation derived from a variety of fruits and vegetables and contains additional vitamins. It is marketed to complement daily diet based on the notion that people do not consume enough fruits and vegetables. Studies on bioavailability suggest that consumption of JP can increase serum levels of alpha-carotene, vitamin C, and folate (1) (2) but studies with other markers, such as lutein, alpha-tocopherol yielded mixed results. JP was shown comparable to standard vitamin C and E supplements (3) but it remains unclear if this product is nutritionally superior to fresh produce. JP was shown to decrease plasma homocysteine levels, a risk factor for cardiovascular disease (9) (1), but the results were not reproducible (4). Studies on cardiovascular effects, such as changes in blood pressure and cholesterol levels are inconclusive (5) (4). JP consumption is thought to reduce oxidative stress and DNA damage (10) (6) (2), and has been associated with a reduction in the symptoms of common cold (12).

Gastrointestinal distress (5) and hive-like rash (11) have been associated with intake of JP in clinical trials.

While there is ongoing research using JP in cancer patients, it has not been proven to prevent or treat cancers. Due to its antioxidant effects, JP may interfere with the actions of some chemotherapy drugs. Cancer patients should discuss use of supplements with their physicians. JP is not a substitute for fresh fruits and vegetables.

Food Sources

Fruits and vegetables.

Purported Uses
  • Cancer prevention
  • Cardiovascular disease
  • Weight loss
Constituents

Blended fruit, vegetable, and berry from: apple, beet, bilberry, blackberry, black currant, blueberry, broccoli, cabbage, carrot, acerola cherry, Concord grape, cranberry, elderberry, kale, orange, peach, papaya, parsley, pineapple, raspberry, red currant, spinach, and tomato. B vitamins, folate, alpha carotene and soy-derived d-alpha-tocopherol are added.(5) (9)

Mechanism of Action

JP is thought to have antioxidant and immunomodulating properties. It reduces some biomarkers of oxidative stress but not others (6) (3) (2). Inflammatory cytokine TNF alpha production increased up to 8 weeks following consumption of JP but decreased after. It had no effect on other markers including IL-4, IL-6, superoxide dismutase or glutathione (6) (7) (8). JP decreased levels of plasma homocysteine, a risk factor for cardiovascular diseases (1) (9), but failed to show similar effect in another study (4). Intake of phytochemical antioxidants may have protective effect on endothelial function by preserving the bioactivity of nitric oxide (4). JP's effects on regulating blood pressure are mixed. Consumption of fresh fruits and vegetables can lower cholesterol levels due to their high fiber content. But JP extract did not appreciably alter cholesterol levels (4) (5).

Pharmacokinetics

Some studies demonstrated that oral consumption of JP capsules can increase the serum levels of beta-carotene, vitamin C, and folate (1) (2). JP has many ingredients that may have different bioavailability profiles. None of the studies conducted so far compared Juice Plus with fresh produce. JP has not been demonstrated to be better absorbed than regular vitamin C and E supplements.

Adverse Reactions

Gastrointestinal distress (5) and hive-like rash (11) were reported in clinical studies.

Case Report: Elevated liver function tests and interference with allopathic therapies. A 51-year-old woman with endometrial cancer experienced hepatotoxicity linked to the use of JP. The patient discontinued using the product and liver function tests normalized over 4 weeks (14).

Herb-Drug Interactions

Theoretically, antioxidants can decrease the efficacy of certain chemotherapy drugs that rely on the generation of free radicals for their cytotoxic effects. Supplements with antioxidant properties are not recommended during chemotherapy.

Herb Lab Interactions

May elevate serum level of some vitamins.

Literature Summary and Critique

Most Juice Plus (JP) studies are partially or fully funded by the Natural Alternative International (NAI) and National Safety Associates (NSA), its manufacturer and distributor. The studies used different doses and formulations of JP. Since dose escalation study has not been conducted, the optimal intake cannot be determined. Lack of appropriate control groups in some studies makes comparison of effects difficult.

Roll S, Nocon M, Willich SN. Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2011 Jan;105(1):118-22.
In this randomized, double-blind, placebo-controlled trial, 529 healthcare professionals, involving nursing staff aged 18-65 years, were given four capsules of juice powder concentrate of fruits and vegetables or placebo daily for 8 months, including a 2-month run-in period. The primary outcome was the number of days with moderate or severe common cold symptoms within 6 months. The mean number of days with moderate or severe common cold symptoms was lower in the treatment group compared to the placebo group. Researchers reported a 20% reduction in moderate or severe common cold symptoms with consumption of this dietary supplement.
However, the participants in this study were primarily nursing staff of which 80% were female. The observations from this study may not hold true for the general population.

Dosage (Inside MSKCC Only)
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References
  1. Samman S, Sivarajah G, Man JC, Ahmad ZI, Petocz P, Caterson ID. A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men. J Nutr. Jul 2003;133(7):2188-2193.
  2. Kawashima A, Madarame T, Koike H, et al. Four week supplementation with mixed fruit and vegetable juice concentrates increased protective serum antioxidants and folate and decreased plasma homocysteine in Japanese subjects. Asia Pac J Clin Nutr. 2007;16(3):411-421.
  3. Bloomer RJ, Goldfarb AH, McKenzie MJ. Oxidative stress response to aerobic exercise: comparison of antioxidant supplements. Med Sci Sports Exerc. Jun 2006;38(6):1098-1105.
  4. Plotnick GD, Corretti MC, Vogel RA, et al. Effect of supplemental phytonutrients on impairment of the flow-mediated brachial artery vasoactivity after a single high-fat meal. J Am Coll Cardiol. May 21 2003;41(10):1744-1749.
  5. Houston MC, Cooil B, Olafsson BJ, Raggi P. Juice Powder Concentrate and Systemic Blood Pressure, Progression of Coronary Artery Calcium and Antioxidant Status in Hypertensive Subjects: A Pilot Study. Evid Based Complement Alternat Med. 2007;4(4):455-462.
  6. Lamprecht M, Oettl K, Schwaberger G, et al. Several indicators of oxidative stress, immunity, and illness improved in trained men consuming an encapsulated juice powder concentrate for 28 weeks. J Nutr. 2007;137(12):2737-2741.
  7. Nantz MP, Rowe CA, Nieves C, Jr., Pervical SS. Immunity and antioxidant capacity in humans is enhanced by consumption of a dried, encapsulated fruit and vegetable juice concentrate. J Nutr. 2006;136(10):2606-2610.
  8. Kiefer I, Prock P, Lawrence C, et al. Supplementation with mixed fruit and vegetable juice concentrates increased serum antioxidants and folate in healthy adults. J Am Coll Nutr. Jun 2004;23(3):205-211.
  9. Panunzio MF, Pisano A, Antonicielloa A, et al. Supplementation with fruit and vegetable concentrate decreases plasma homocysteine levels in a dietary controlled trial. Nutr Res. 2003;23(9):1221-1228.
  10. Smith MJ, et al. Supplementation with fruit and vegetable extracts may decrease DNA damage in the peripheral lymphocytes on an elderly population. Nutr Res. 1999;19:1507-18.
  11. Inserra PF, et al. Immune function in elderly smokers and nonsmokers improves during supplementation with fruit and vegetable extracts. Integr Med. 1999;2:3-10.
  12. Roll S, Nocon M, Willich SN. Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2011 Jan;105(1):118-22.
  13. Goldfarb AH, Garten RS, Cho C, et al. Effects of a fruit/berry/vegetable supplement on muscle function and oxidative stress. Med Sci Sports Exerc. Mar 2011;43(3):501-508.
  14. Naing A, Aaron J, Kurzrock R. Juice plus or toxicity plus. Am J Med. Jan 2010;123(1):e1-2.

Consumer Information

How It Works

Bottom Line: Juice Plus has not been shown to treat or prevent cancer.

Juice Plus is a dietary supplement that contains dried concentrates of fruits and vegetables. It has been studied for its antioxidant and cardiovascular effects. But more studies are needed. There are ongoing clinical studies of Juice Plus in cancer patients but it has not been proven to treat or prevent cancer. Juice Plus is not a substitute for fresh fruits and vegetables.

Purported Uses
  • To prevent and treat cancer
    No scientific evidence supports this use.
  • To prevent and manage heart disease
    Small studies showed mixed results. Well designed clinical trials are needed.
Research Evidence

Common cold:
In this randomized, double-blind, placebo-controlled trial, 529 healthcare professionals, involving nursing staff aged 18-65 years, were given four capsules of juice powder concentrate of fruits and vegetables or placebo daily for 8 months, including a 2-month run-in period. The primary outcome was the number of days with moderate or severe common cold symptoms within 6 months. The mean number of days with moderate or severe common cold symptoms was lower in the treatment group compared to the placebo group. Researchers reported a 20% reduction in moderate or severe common cold symptoms with consumption of this dietary supplement.
However, the participants in this study were primarily nursing staff of which 80% were female. The observations from this study may not hold true for the general population.

Do Not Take If

You are undergoing chemotherapy or radiation therapy (antioxidants may reduce their effectiveness).

Side Effects

Some patients reported gastrointestinal distress and hive-like rash in clinical studies.

E-mail your questions and comments to aboutherbs@mskcc.org.